Examining the relationship between death attitude and AD completion and attitude among older Chinese Americans

研究老年华裔美国人的死亡态度与 AD 完成度和态度之间的关系

• 批准号: 10575699
• 负责人: Kaipeng Wang
• 金额: $ 8.56万
• 依托单位: UNIVERSITY OF DENVER (COLORADO SEMINARY)
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-15 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10575699
• 关键词: Acculturation; Address; Advance Care Planning; Advance Directives; Affect; Age; Aging; American; Asian Americans; Attitude; Awareness; Behavioral Model; Buddhism; Cessation of life; Chinese; Chinese American; Communication; Cross-Sectional Studies; Data; Demographic Factors; Elderly; Ensure; Ethnic Population; Family; Family Relationship; Family member; Focus Groups; Future; Goals; Grant; Health; Health Personnel; Health Professional; Health behavior; Healthcare; Hospitals; Immigrant; Individual; Intervention; Knowledge; Legal; Life; Literature; Medical; Medical Care Costs; Methods; Minority; Minority Groups; Modeling; Participant; Patients; Personal Satisfaction; Persons; Play; Population; Positioning Attribute; Predisposing Factor; Quality of Care; Questionnaires; Religion; Religiosity; Research; Role; Shapes; Surveys; Terminal Disease; Theoretical model; United States; Work; age group; aged; behavior change; design; disparity elimination; end of life; end of life care; expectation; health service use; improved; intergenerational; multiple chronic conditions; negative affect; preference; psychosocial; sex; social; social factors; structural determinants

PROJECT ABSTRACT Advance directive (AD) completion is associated with improved quality of end-of-life (EOL) care, reduced use of aggressive and costly medical treatments, lower likelihood of in-hospital deaths, and lessened decisional burden of healthcare surrogates. Older Chinese Americans, despite being the fastest growing and the second largest immigrant population in the United States, have significantly lower AD completion rate (10%-14%) than the general older American population (37%-60%). Although a few studies have examined demographic and cultural factors of AD completion among older Chinese Americans, death attitude, a modifiable and culturally salient factor, has been overlooked. Death attitude closely intersects with many aspects of Chinese culture, such as filial piety, centrality of the family, familial hierarchy, and religion. Furthermore, Chinese Americans believe that discussing death brings bad luck and therefore they tend to avoid topics related to death in conversation, which greatly hinders advance care planning and negatively affects the well-being of older Chinese Americans and their family members. To address this knowledge gap, this project will use an explanatory sequential mixed-methods design and focus on the following specific aims: (Aim 1) identify factors, i.e., demographic, social, and structural factors, that are associated with older Chinese Americans’ death attitude; (Aim 2) examine the association between death attitude and attitude toward AD and AD completion among older Chinese Americans; and (Aim 3) evaluate how and in what ways any significant factors identified in Aim 2 influence older Chinese Americans’ AD completion and attitude toward AD through focus groups. Informed by the Andersen’s Health Service Utilization Model, we will collect and analyze quantitative survey data to address Aims 1 and 2. Then, informed by the Transtheoretical Model for Behavioral Change, we will collect and analyze qualitative data from focus groups to address Aim 3. Findings will inform future research on developing, evaluating, and implementing culturally responsive interventions that improve advance care planning and AD completion and fill critical gaps in research specifically to the advance care planning needs among older Chinese Americans.

项目摘要 完成预先指示 (AD) 与提高临终 (EOL) 护理质量、减少使用量相关 积极且昂贵的医疗治疗、院内死亡的可能性降低以及决策减少 老年华裔美国人的负担，尽管是增长最快且位居第二的。 美国最大的移民人口，AD 完成率 (10%-14%) 明显低于 尽管一些研究调查了人口统计和美国老年人口（37%-60%）。 老年华裔美国人AD完成的文化因素、死亡态度、可改变的和文化上的 死亡态度与中国文化的许多方面密切相关。 例如孝道、家庭中心地位、家族等级制度和宗教。 认为讨论死亡会带来厄运，因此他们倾向于回避与死亡有关的话题 谈话，这极大地阻碍了预先护理计划并对老年人的福祉产生负面影响 为了解决这一知识差距，该项目将使用 解释性顺序混合方法设计并侧重于以下具体目标：（目标 1）确定因素， 即与老年华裔美国人死亡相关的人口、社会和结构因素 态度；（目标 2）检查死亡态度与对 AD 和 AD 完成的态度之间的关联 在年长的华裔美国人中；以及（目标 3）评估如何以及以何种方式识别出任何重要因素 目标 2 通过焦点小组影响老年华裔美国人的 AD 完成情况和对 AD 的态度。 以安徒生健康服务利用模型为基础，我们将收集并分析定量调查 数据来解决目标 1 和 2。然后，根据行为改变的跨理论模型，我们将 收集和分析焦点小组的定性数据以实现目标 3。调查结果将为未来的研究提供信息 制定、评估和实施改善预先护理的文化响应干预措施 规划和 AD 完成，并填补专门针对预先护理规划需求的研究的关键空白 在年长的华裔美国人中。